Tuberculosis: A New Antibiotic Appears Effective Against Multidrug-Resistant Strains

A new antibiotic appears effective against deadly strains of tuberculosis resistant to nearly all currently available treatments for the infectious disease. The antibiotic, linezolid (brand name Zyvox), recently saved the lives of four women and one girl who were gravely ill with multidrug-resistant tuberculosis at New York City's Bellevue Hospital, according to a report by physicians from New York University School of Medicine. The patients, ages 10 to 54, were resistant to at least eight, and up to 14, TB therapies.

"They were in a lot of trouble, and we had run out of treatment options," said William Rom, MD, professor of medicine and environmental medicine at NYU School of Medicine. "Trying the linezolid was a real act of desperation," said Timothy Harkin, MD, assistant professor of medicine and assistant director of Bellevue's chest service. "This certainly seems like a promising medication for multidrug-resistant TB and there is a continuing need for new antibiotics for this disease," he said.

Harkin and Rom said further studies are needed to confirm their case reports, and they hope the drug will be tested in large clinical trials sponsored by the World Health Organization. The NYU physicians presented the cases to colleagues at the 99th International Conference of the American Thoracic Society in Seattle ("Linezolid: A Promising New Agent for Multi-Drug Resistant Tuberculosis Treatment," Abstract P621. Presented May 21, 2003).

Linezolid is a new class of antibiotic that was approved by the U.S. Food and Drug Administration to treat certain strains of bacteria resistant to standard penicillin and methicillin and to more powerful drugs like vancomycin. It is not approved to treat drug-resistant TB. However, Bellevue doctors decided to try linezolid when all other available therapies, including the most powerful drugs yet available for drug-resistant TB, failed to improve the health of the five patients.

Patients took linezolid twice a day in pill form for 9-33 months. Four patients also received interferon gamma in an aerosolized form three times a week. Following treatment, there was no sign of TB in sputum from the patients' lungs. Moreover, physicians said that the drug did not seem to be associated with many severe side effects. Two patients continue on treatment and are doing well. One patient relapsed two years after completing treatment, but died of unrelated causes before she could be retreated.

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